Former R.I. physician convicted of Medicare fraud

BOSTON — A physician and former employee of New England Pain Management Associates, Inc. was convicted Sept. 21 by a federal jury of conspiring to falsify patient medical records between May 2012 and May 2013 in an effort to obtain payments from Medicare and commercial insurers for medical services that were not performed.

Moustafa Moataz Aboshady, 36, of Lake Forest, Calif., was convicted on one count of conspiracy to make false statements in connection with health care benefit programs and two counts of making false statements in connection with health care benefit programs, according to the office U.S. Attorney for the District of Massachusetts, Andrew E. Lelling.

Aboshady was licensed as a resident in Rhode Island. That license has since expired, according to Joseph Wendelken, spokesman for the R.I. Department of Health.

During the time of the conspiracy, Aboshady was a medical resident in Massachusetts and Rhode Island, employed at New England Wellness & Pain Management, P.C., which was also known as New England Pain Associates, P.C., Greystone Pain Management, Inc., and New England Pain Institute, P.C., or NEPA. NEPA had locations in Massachusetts and Rhode Island, and was operated by Fathallah Mashali, a pain management physician, according to Lelling’s office.

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In March, Mashali pleaded guilty to 27 counts of health care fraud, one count of conspiracy to commit mail fraud, and 16 counts of money laundering. He was sentenced to eight years in prison and three years of supervised release.

Mashali was among Rhode Island physicians receiving the highest Medicaid reimbursements in according to a Centers for Medicaid and Medicare Services report released in 2014. According to the report, Mashali received $3.7 million in reimbursements for treating 727 patients. Mashali’s Rhode Island medical license was suspended in 2013, according to Wendelken.

Aboshady was part of a conspiracy involving Mashali, other members of NEPA, and members of a satellite office in Cairo, Egypt, whose purpose was to falsify medical records and urine drug test results to support claims for payment to Medicare and insurers for services that Mashali did not render, Lelling’s office reported.

Part of the conspiracy involved falsification of patient encounter notes. Such false information included, but was not limited to, detailed descriptions of extensive physical examinations and treatment plans, and durations of face-to-face interactions with patients exceeding 20 to 40 minutes per appointment, to create the appearance of lengthy and involved patient encounters, when in fact these services did not take place. Aboshady instructed the Cairo office to create false electronic signatures on the encounter notes and how to make the timestamps for those signatures look realistic.

Aboshady was also responsible, in conjunction with the office in Cairo, for the fabrication of urine drug test results with false test dates, so that the tests appeared to have been performed within days of specimen collection rather than weeks or months thereafter. This information was necessary to support urine drug test billing codes submitted to Medicare and insurance companies.  In fact, NEPA tested patients’ urine weeks and sometimes three months after the specimens had been collected and stored unrefrigerated in large plastic bags and containers.

The charges carry a potential sentence in federal district court of no greater than five years in prison, three years of supervised release, a fine of $250,000 and restitution.

Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.